Jean-Charles Le Huec

21st April 2011

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Jean-Charles Le Huec, chief of the spine unit and chair of the Department of Orthopaedics and Traumatology at the Bordeaux University Hospital, Bordeaux, France, has seen orthopaedic surgery develop alongside his career. In this interview, he told Spinal News International about the people who have supported his work and new projects he is involved with as incoming president of SAS–The International Society for the Advancement of Spine Surgery.

When did you decide you wanted a career in medicine? Why orthopaedic surgery?

My interest began very early, when I was 10 years old. My grandfather was very interested in biology; he was an autodidact and always reading books and magazines about health, biology and other subjects. He was a carpenter building ships in one of the biggest harbours located on the Atlantic coast of Brittany (Western France). I was always with him during my vacations, building small sailing boats (maquettes) and we used to go to the beach located 100m away from his house to test them. This was probably the first reason to specialise in orthopaedics. The second was that my father was a professor of mechanics, so ever since a young age, I had been soaked in solving load and resistance problems!

Who has inspired you in your career and what advice of theirs do you remember today?

My parents always gave me important support and advice. They had very modest means when I was born, but worked hard for their three children to have the best education. They never pushed me in one direction or another, but were always pushing me to move forward. “Use your talents and enhance them,” they used to say. This is something very important to obtain success. When I decided to go to medical school, I received full support and I was impressed by the father of one of my best friends. He was a cardiologist. We had good discussions with him about the future, life and all the possible progress of science. He was optimistic, but at the same time very prudent, always asking for evidence to support innovation. He used to say “I want the best for my patients but I want to be sure that this new treatment is the best”.

In high school I had the opportunity to be integrated in a wonderful Jesuit college where the teachers and professors were very innovative, allowing the development of projects and supporting us in advanced research. We had to create everything, including plans to find money and to build a project. Then we had full support under the supervision of a professor, or an expert. Two half days per week, we were involved in the project and each year we had to present our annual work to the community during a meeting day with all the families. I think this foundation gave me a taste for research. I was involved in a team named Biology Research, but the topics varied along the years.

What have been your proudest moments?

In Europe, and particularly in France, diplomas are very important. We have prestigious schools and passing exams is a very important time in life. This gives you a passport for your future career. Graduation in high school is important, but the first year of medical school is a very selective exam. Then you progressively move to your medical thesis and this represents the best gift you can give to your parents and family because they all suffered with the hard work you did and with the good times you could not share with them. Becoming an MD is also an important step, because after that it is mainly a question of choice, opportunity and support. Sharing good times with your family and friends is also very important.

How has orthopaedic surgery evolved since you began your career?

Orthopaedic surgery has evolved immensely in the last 30 years. When I started as a resident, in the early 80s, only hip arthroplasty was a routine procedure. I had the opportunity to see the development of knee surgery: ligamentoplasty (first artificial and then back to natural ligaments) and total knee arthroplasty. I even did a fellowship in Montreal with professor Cloutier, one of the pioneers with Insall and Freeman. In the early 90s shoulder surgery started to become popular and I learnt a lot from G Walch in Lyon (France), and also with some Americans like B Cofield in the Mayo clinic. Rotator cuff tear used to be treated only by rheumatologists and is now mainly treated by orthopaedic surgeons since arthroscopy allows performing good repair. Shoulder arthroplasty is now a mature technique with regular and reversed implants.

During the last 20 years, spine surgery has seen tremendous changes. Before 1985, there were two categories: adolescent idiopathic scoliosis treated by paediatric and orthopaedic surgeons, trauma cases treated by ortho and neuro (but not in the same way) and degenerative cases. For scoliosis and trauma, the use of hardware was growing as this was the only way to restore a good shape or to stabilise the spine. The Cotrel Dubousset’s technique was a revolution at this time. In the middle of the 90s, the degenerative spine, which was previously treated mainly by decompression +/- fusion, started to be treated with pedicular screws and cages with the summit in 1997 named the cage rage! I remember at NASS, the session about complications, it was incredible. Surgeons had started to use a technology dedicated for scoliosis and trauma to treat degenerative cases only because this was the only technology available. This was supported by the fact that fusion rate was much higher as demonstrated in many good papers. But at the same time in the early 2000, many people showed the problem of adjacent disc disease explaining that fusion was responsible of overstress. This was the main argument to develop non-fusion technologies and the disc arthroplasties then came along. Supported by good marketing, based on knee and hip experience, many prostheses were launched in the market. Cervical was easier to perform than lumbar and the success was international. Finally, with 10 years follow-up now it seems obvious that if keeping motion is important, disc_ arthoplasty should move to a new concept which is spine shape adaptation. The spine morphology, according to pelvic parameters, seems much more important than motion preservation. Adjacent disc disease is a myth that is mainly the consequence of bad surgical technique which does not respect basic anatomical and spine parameters. Fusion is a natural process of the aging spine; the problem is that disc degeneration produces spine kyphosis with spine imbalance. Restoring spine balance is the key to success. Enhanced disc arthoplasties could be a solution at an early stage, but spine arthrodesis respecting biomechanical parameters is probably the most important solution we have.

What have been your most memorable clinical cases?

Tumour and revision cases where you have to combine two or three steps within a multidisciplinary team are extremely challenging, but strategy is the key. I remember cases which have needed multiple operations for scoliosis with krankshaft phenomenon or dome shaped spondylolisthesis which have been very badly treated without biomechanical restoration which have needed huge surgery, finally resulting in good clinical success. Those patients are always friends after such an experience.

What do you hope to achieve as incoming president of the International Society for the Advancement of Spine Surgery (ISASS) this year?

ISASS is the society for spine surgeons and should become the strongest international society. This does not mean that classical surgery is the only way forward. The aim of the society is also to promote new treatment and solutions. But we want to demonstrate that what surgeons do is based on good and strong clinical evidence. Prospective data collection is key to support our daily work. I want to promote an international database that will allow all surgeons in the world to upload their data and analyse their own results, comparing them with a global database. Issues around insurance and the healthcare systems in many countries are very important for spine surgeons but this is mainly because of the lack of data to support re-imbursement. An anonymous, international, Internet-based system will the best way to demonstrate our efficiency and safety. All kinds of treatment can be used but comparison will be possible based on thousands of cases.

How do you see the field of spinal surgery developing in the future?

Biology will be the key for diagnosis and early treatment. I believe more in drug therapy than in cell therapy, but I am involved with both sides. We will see.

Which technique or technology had a profound effect on your career?

Endoscopy and video-assisted techniques have changed my way of treating the spine. Then bone substitutes and bone induction technologies came and are very useful, even if some enhancement is still in progress. Finally navigation in its last development with peri-operative 3D image acquisition is one of the most promising technologies for the future, allowing decreasing extensile approach and promoting accuracy. The future is full of hope!

What are your current areas of research?

Bone substitutes, which were the theme of my PhD, are still a very important field for me in combination with new biology possibilities and the latest technologies like nanotechnology. 3D vision of the spine pre-operatively with the EOS system (Biospace, France), which is a low dose radiation system providing full standing 3D images, is important in the analysis of, not only scoliosis, but lumbalgia and compensation phenomenon. Combined with peri-operative 3D correction of the spine, this will be the next most important step in the coming years.

What is the most interesting paper you have come across recently?

Carragee’s paper about the negative effects of disc puncture and the poor results of discography was very interesting. Promoting a technique and coming back years later showing that probably that technique was not so contributive with the support of additional papers in the same direction is a very constructive way of moving forward.

Outside of medicine, what are your interests?

I like teaching and doing research. But my hobbies are flying for fun and painting. I also enjoy walking (or jogging on the beach) on the coast. Family time is also important for me.

Fact File

Appointments

Chief of the spine unit and chair of the Department of Orthopaedics and Traumatology at the Bordeaux University Hospital, Bordeaux, France

Director of the Laboratory of Surgical Research at the Bordeaux University School of Medicine